Service d'Anesthésie Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69394, Lyon Cedex 03, France.
Département de Chirurgie cardiaque, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, 59 boulevard Pinel, 69394, Lyon Cedex 03, France.
J Clin Monit Comput. 2020 Jun;34(3):515-523. doi: 10.1007/s10877-019-00352-6. Epub 2019 Jul 10.
Conflicting results have been published on prognostic significance of central venous to arterial PCO difference (∆PCO) after cardiac surgery. We compared the prognostic value of ∆PCO on intensive care unit (ICU) admission to an original algorithm combining ∆PCO, ERO and lactate to identify different risk profiles. Additionally, we described the evolution of ∆PCO and its correlations with ERO and lactate during the first postoperative day (POD1). In this monocentre, prospective, and pilot study, 25 patients undergoing conventional cardiac surgery were included. Central venous and arterial blood gases were collected on ICU admission and at 6, 12 and 24 h postoperatively. High ∆PCO (≥ 6 mmHg) on ICU admission was found to be very frequent (64% of patients). Correlations between ∆PCO and ERO or lactate for POD1 values and variations were weak or non-existent. On ICU admission, a high ∆PCO did not predict a prolonged ICU length of stay (LOS). Conversely, a significant increase in both ICU and hospital LOS was observed in high-risk patients identified by the algorithm: 3.5 (3.0-6.3) days versus 7.0 (6.0-8.0) days (p = 0.01) and 12.0 (8.0-15.0) versus 8.0 (8.0-9.0) days (p < 0.01), respectively. An algorithm incorporating ICU admission values of ∆PCO, ERO and lactate defined a high-risk profile that predicted prolonged ICU and hospital stays better than ∆PCO alone.
关于心脏手术后中心静脉到动脉 PCO 差值（∆PCO）的预后意义，已有相互矛盾的结果发表。我们比较了 ∆PCO 在重症监护病房（ICU）入院时的预后价值，以及一种将 ∆PCO、ERO 和乳酸结合起来识别不同风险特征的原始算法。此外，我们描述了在术后第 1 天（POD1）期间 ∆PCO 的演变及其与 ERO 和乳酸的相关性。在这项单中心、前瞻性和初步研究中，纳入了 25 例行常规心脏手术的患者。在 ICU 入院时和术后 6、12 和 24 小时采集中心静脉和动脉血气。发现 ICU 入院时高 ∆PCO（≥6mmHg）非常常见（64%的患者）。∆PCO 与 ERO 或乳酸在 POD1 值和变化方面的相关性较弱或不存在。在 ICU 入院时，高 ∆PCO 并不能预测 ICU 住院时间延长（LOS）。相反，在通过算法确定的高危患者中观察到 ICU 和住院 LOS 显著增加：3.5（3.0-6.3）天对 7.0（6.0-8.0）天（p=0.01）和 12.0（8.0-15.0）天对 8.0（8.0-9.0）天（p<0.01）。一种将 ∆PCO、ERO 和乳酸的 ICU 入院值纳入的算法定义了一个高危特征，该特征预测 ICU 和住院时间延长的效果优于单独的 ∆PCO。
